Marine Lt. Theresa Larson was forcing herself to vomit as many as five times a day when she was medically evacuated out of Fallujah, Iraq.
The problem had started back at Camp Pendleton in California, but Larson was doing her job and keeping it together, so the very few people who knew about it backed her up.
“I convinced everyone around me that I’d be fine. When I deploy obviously it’s going to go away because I’m going to be super busy,” Larson said. “So I deployed and that’s where things started to unravel little by little.”
It was 2005, Larson was escorting female insurgents and leading convoys. She was 23 at the time, a tall, fit woman heading a platoon of 54 Marines, most of them men.
During her deployment she’d sought help from a mental health counselor, but it wasn’t working.
“It was like, ‘You’re throwing up? Why would you do that?’” Larson said. “They were used to seeing trauma and post-traumatic stress. I began to realize, OK, no one understands this.”
Larson knew she was out of control. Her eating disorder had taken over. She worried that if she made a bad decision someone might get hurt.
Larson had been close with her father since her mother died from an illness when she was 10. In letters to him during her deployment she confided things were getting worse.
“My dad had written me a letter and he was like, ‘Theresa, the Marine Corps is a big green machine. They’re going to go on. You’re not, the way you are. You’re like a roller coaster, so get help. It’s your life,’” Larson said.
That letter was a turning point for Larson. She met with her commander and told him she needed to go home to get well.
When Larson returned to Camp Pendleton she said she fought to attend intensive outpatient treatment at a facility off base. She completed treatment but was ultimately discharged for poor performance.
“Taking a stand meant me looking like an idiot in the Marine Corps. I looked like a piece of shit,” Larson said.
Dr. Neeru Bakshi, medical director at the Eating Recovery Center in Bellevue, Washington, an intensive outpatient and residential treatment facility, said service members face a perfect storm of risk factors for eating disorders: combat stress, intense pressure to perform and strict weight limits.
“They’ll actually use their eating disorder to support what they need for those physical requirements,” Bakshi said. She said vets would come to her saying they spent six hours a day in the gym to meet those requirements. “That’s actually a form of their eating disorder.”
A report by the Armed Forces Health Surveillance Center found that over a 10-year period ending in 2013, 3,527 service members were diagnosed with some form of eating disorder, usually anorexia or bulimia.
As a young female Marine, Larson was part the highest risk group. Researchers say many more eating disorders were likely undiagnosed.
Bakshi said part of the problem is a lack of support for early intervention around eating disorders within the military. “It’s just this set up for the person to be actively engaging in their eating disorder and not getting any kind of help,” Bakshi said.
Besides the physical demands of the job, Bakshi said eating disorders can develop as a result of post-traumatic stress disorder or sexual assault.
“The eating disorder really grows in these dark and secretive places. The eating disorder takes hold and really creates its own narrative for the person that’s not their own,” Bakshi said.
That’s what Colette Candy is trying to change. She’s a psychologist at Madigan Army Medical Center in Tacoma, Washington, and is one of a handful who treat eating disorders. She said many soldiers she sees have kept their condition secret throughout their military careers – even as long as 20 years.
Candy is treating 10 soldiers – a caseload that’s now large enough that she’s started her first eating disorder therapy group and added a dietitian to the care team.
But she can’t help everybody. She said about a third of her patients have to seek a higher level of care outside the military.
Even so, Candy said she’s also had remarkable successes. “I’ve had a guy with a 17-year history turn it around just with outpatient treatments. So you can never tell who’s going to respond,” Candy said.
It took years, but Larson is one of those service members who did respond.
After leaving the Marines she played professional softball in Italy, where through a lot of journaling and reflection she managed to get well.
A decade after her discharge from the Marines, she owns a physical therapy and wellness company in San Diego. Once a week she teaches an adaptive exercise class to fellow vets.
Larson said helping veterans who’ve lost limbs is an important part of her life and her recovery.
She still gets anxious and depressed at times. Larson knows she needs to pay attention to these things to keep her emotions and anxieties in check so she doesn’t turn back to disordered eating. She uses meditation to keep herself centered.
Larson now blogs and gives speeches about her experience with bulimia in the military. A book about her experience is due out next month.
“I’m very proud of my service and the people I got to work with for the most part. And I don't blame the Marine Corps for anything. I think things could have been much better, but that’s why we’re starting this conversation: to get people help before they’re broken,” Larson said.
Researchers for the Department of Defense noted that health care providers and unit leaders should be made aware of how prevalent serious eating disorders are as well as other unrecognized abnormal eating behaviors.
Their report notes the military already has a way to identify people who might need that help – the regular height and weight assessments that are required of troops. But interpreting this data can be subtle and easily overlooked.
However, ignoring the problem effects the health and well-being of affected service members as well as the military operational effectiveness. It’s a matter of making sure that commanders understand eating disorders and encourage those who need treatment to seek it.
To do that, Larson said it needs to be OK to ask for help. “You know there’s going to be struggle. Some people may not show it because there’s shame involved. But you better believe there will be, so take care of it before it becomes a problem.”